How should vaccination services be planned, organized, and managed? Results from a survey on the Italian vaccination services.

BACKGROUND: Quality improvement is an increasingly recognized approach to maximize service effectiveness and minimize costs in public health. However, the Italian law never provided for the institutional accreditation of vaccination services. Furthermore, a recently approved law added six more compulsory vaccinations to the original four, which has led to a considerable increase in vaccination efforts, without any previous resources evaluation. The aim of the study was to investigate structural, organizational and managerial characteristics of the Italian vaccination services, in order to suggest the adoption of adequate quality standards. STUDY DESIGN: A survey involving the representatives of the Italian Regions and Autonomous Provinces was performed between September 2017 and September 2018. METHODS: An online questionnaire, including 26 items, designed to evaluate the structural, organizational and managerial characteristics of vaccination services was administered. The correlation between the number of vaccination centres and the coverage for each region was used to evaluate the performance of the vaccination services. RESULTS: Respondents from seven Regions, totaling >15,000,000 inhabitants, answered the questionnaire. Overall, each vaccination service was potentially accessed by an average of 519 children aged zero to 24 months, with a ß-coefficient of -0.87 (p = 0.01) for infant vaccination coverage in 2016. Eighty-five percent of vaccination services were provided with architectural features to accommodate the disabled but only 49% provided reserved parking lots. An average of 0.4 physicians and 0.6 other healthcare workers per 10,000 inhabitants were employed in vaccination services, with complete computerization in 74% of them. CONCLUSION: The inverse relation between vaccination services' spatial accessibility and vaccination coverage suggests that distance and accessibility of vaccination services should be considered in planning. This survey constitutes a baseline data for Italian vaccination services that could be useful for decision makers in establishing minimum requirements to provide high-quality preventive healthcare service.

Nano-TiO2-based photocatalytic disinfection of environmental surfaces contaminated by meticillin-resistant Staphylococcus aureus.

BACKGROUND: Traditional cleaning and disinfection methods are inefficient for complete decontamination of hospital surfaces from meticillin-resistant Staphylococcus aureus (MRSA). Additional methods, such as nano-TiO2-based photocatalytic disinfection (PCD), could be helpful. AIM: To evaluate anti-MRSA activity of PCD on polyvinyl chloride (PVC) surfaces in natural-like conditions. METHODS: Two identical PVC surfaces were used, and nano-TiO2 was incorporated into one of them. The surfaces were contaminated with MRSA isolated from hospitalized patients using a mist sprayer to simulate the mode of environmental contamination caused by a carrier. MRSA cell density was assessed before contamination until 180min after contamination using Rodac plates. The differences between test and control surfaces in terms of MRSA density and log MRSA density reduction were assessed using parametric and non-parametric statistical tests. Five strains were tested, and each strain was tested five times. FINDINGS: The highest median MRSA densities [46.3 and 43.1 colony-forming units (cfu)/cm(2) for control and test surfaces, respectively] were detected 45min after contamination. Median MRSA densities 180min after contamination were 10.1 and 0.7cfu/cm(2) for control and test surfaces, respectively (P<0.01). Log MRSA density reduction attributable to PCD was 1.16logcfu/cm(2), corresponding to 93% reduction of the baseline MRSA contamination. CONCLUSIONS: The disinfectant activity remained stable throughout the 25 testing occasions, despite between-test cleaning and disinfection. The anti-MRSA activity of PCD was compatible with the benchmark for surface hygiene in hospitals (<1cfu/cm(2)), but required 3h of exposure to photocatalysis. Thus, PCD could be considered for non-clinical surfaces. However, for clinical surfaces, PCD should be regarded as supplemental to conventional decontamination procedures, rather than an alternative.

An insight into the occurrence of suicides in jails of an Italian region.

The objective of this study is to explore the personal and environmental causes of suicides in jails of an Italian region, by evaluating the extent of the phenomenon, in order to devise strategies for prevention. The examined documentation deals with all cases of suicide among detainees in the 14 prisons of the region Lazio between 01/01/2008 and 31/12/2014. The factors considered for evaluation concerns the are socio-demographics (age, gender, nationality) as well as legal aspects, prison characteristics (type of crime, judicial state) and method used for the suicide. The results show that the method to commit suicide in prisoners of Lazio is hanged. Suicides occur especially in Italian prisoners. Most prison inmates commit suicide less than one year before the end of the detention period. Since the majority of risk factors for suicide are present before the subject enters prison, it is not easy to observe and check the prisoners once they are in jail. The evaluation of the prisoners should be done during the phase when they first enter the jail and not after the intervening variables associated with the detention have had their effects. This suggests that further studies are necessary to better understand the phenomenon and evaluate the possibility to introduce effective preventive measures.

Risk management in surgery.

Malpractice is the responsible for the greatest number of legal claims. At the present time, legal actions against physicians in Italy are 15,000 per year, and a stunning increase about costs to refund patients injured by therapeutic and diagnostic errors is expected. The method for the medical prevention is "Risk Management", that is the setting-up of organizational instruments, methods and actions that enable the measurement or estimation of medical risk; it allows to develop strategies to govern and reduce medical error. In the present work, the reconstruction about the history of risk management in Italy was carried out. After then the latest initiatives undertaken by Italy about the issue of risk management were examined.

Nanohydroxyapatite-based bone graft substitute in tunnel enlargement after ACL surgery: RMN study.

BACKGROUND AND AIM: A successful anterior cruciate ligament reconstruction (ACL) requires solid healing of the tendon graft in the bone tunnel. New biological strategies have already been proposed with the aim of improving ACL graft healing and therefore allowing a faster rehabilitative program. The aim of this prospective study was to clinically and radiologically evaluate the efficacy of nanohydroxyapatite bone-base grafts in facilitating bone-tendon incorporation after ACL reconstruction with hamstrings (HS). As far as we know, this is the first study that has tried to asses the efficacy of such a type of bone substitute on human beings. MATERIALS AND METHODS: 40 male patients with chronic ACL rupture who underwent surgical reconstruction with 4-strand semitendinosus and gracilis tendon autograft via a single-bundle technique. Patients were randomly assigned to enter group A (20 patients, nanohydroxyapatite group) or group B (20 patients, control group). Preoperative and postoperative clinical evaluation was always performed, in a blinded way, assessing the Lachman and Pivot-shift tests and range of motion (ROM) of the affected knee. The Lysholm knee score, Tegner activity level, subjective and objective International Knee Documentation Committee (IKDC) forms, and 30 lb KT-1000 arthrometer evaluations. Patients underwent a magnetic resonance imaging (MRI) exam at 30, 90 and 180 days after surgery by the same musculoskeletal radiologist in a blinded way. RESULTS: As for the clinical evaluation, Lysholm, Tegner, IKDC scales, and KT-1000 arthrometer results did not show any significant difference between the two groups. Radiological data show a tendency toward better results in regard to the graft strength signal, the graftbone interface, and bone edema remodeling process, these parameters show significant differences between the two groups only at the short or mid-term follow-ups, while they are never significant at the mid-to long-term follow-up. CONCLUSIONS: In conclusion the use of nanohydroxyapatite bone substitute does not provide significant clinical improvements in terms of better knee stability or patient satisfaction.

Alcohol is not a risk factor for oral cancer in nonsmoking, betel quid non-chewing individuals. A meta-analysis update.

BACKGROUND: Alcohol drinking is associated with high oral cancer (OC) risk. This association is particularly evident in tobacco smoking/betel quid (BQ) chewing subjects. In a previous stratified meta-analysis (Petti S et al., Cancer Epidemiol 2012) we reported that drinking was inversely associated with OC in non-smoking BQ non-chewing individuals, while this association was reversed in smoking individuals. However, the previous study could be excessively influenced by a large primary study, which yielded more than 50% of the weight of all the primary studies. Therefore, we updated this analysis using only recent studies. METHODS: Case-control studies published between 2010 and 2012 were searched. In each study, non-smoking/ BQ non-chewing exposed (ever routine drinkers) and unexposed (never drinkers) subjects with (cases)/without (controls) OC were extracted and odds ratio (OR) calculated. Between-study heterogeneity was assessed with Cochran's Q. Publication bias was formally assessed with trim and fill method. Sensitivity analysis to inclusion criteria was made. The pooled OR was assessed with the fixed- and random-effect methods and corrected for publication bias. RESULTS: Seven of these studies met the inclusion criteria: they were not heterogeneous enough. Correction for publication bias was not necessary and provided only one missing study. The OR estimates were 0.70 (95% confidence interval -95CI, 0.51-0.98), 0.70 (95CI, 0.51-0.96), 0.75 (95CI, 0.54-1.03) with the three methods. Sensitivity analysis did not change the OR estimates considerably. CONCLUSIONS: This analysis corroborated the results of the previous analysis, confirming that drinking was inversely associated with OC in non-smoking, BQ non-chewing subjects.